DETERMINING MEDICAL EQUIVALENCE IN
SOCIAL SECURITY DISABILITY CASES
In determining if you are disabled in a Social Security case, the Social Security Administration (SSA) has compiled what is referred to as a Listing of Impairments and the criteria to meet these listings based on certain severe and medically determinable illnesses. These Listings provide detailed information that must be medically documented by your treating physicians, hospitals, other medical providers, and consultative examiners. Depending on your impairments and the access you have to medical care, it can be a difficult task to meet each criterion in the designated listings described by SSA. Hence, SSA has implemented instructions for determining medical equivalence in certain cases.
The SSA Medical Equivalence policy differs from the Listing level policy in that some listings require a certain number of hospitalizations or other criteria to meet a specific listing. Medical Equivalency considers “quality of” instead of “quantity of”. This also takes into account the limited use of emergency departments and hospital interventions depending on the medical resources available to a patient. A finding of medical equivalence depends on the facts of the case. A combination of impairments may equal a Listing under medical equivalency when you consider the chronicity and duration of an impairment despite aggressive treatment.
Per POMS DI 25220.010, an impairment is considered to be medically equivalent to a listed impairment if it is at least equal in severity and duration to the criteria of any listed impairment.
Medical Equivalence can be determined in a couple different ways. One being if you have a Listed Impairment but you do not meet the criteria of one or more of the findings specified in the particular listing, or you have all of the findings, but there are not as severe as specified in the listing. However, if you have other findings related to your impairment that are at least of equal medical significance to the required findings, then medical equivalence applies.
Second, if you have an impairment that is not listed in the Listing of impairments, but can be compared with other closely related impairments, and your findings related to your impairments are at least of equal medical significance to those of a listed impairment. In these cases, the listed impairments can be compared to your findings and the Social Security Administration may find that your impairment is medically equivalent the comparable listing.
Deciding medical equivalence or whether or not your condition meets a Listing, can be a difficult and confusing process. Call one of the experienced disability attorneys at Gardberg & Kemmerly, P.C. today at 251-343-1111 for a free consultation. Gardberg & Kemmerly specialize in helping the injured and disabled.